• Archives of Reconstructive Microsurgery
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• v.9 no.1
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• pp.1-5
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• 2000

The microsurgical reconstruction is necessary for elderly patients to treat severe trauma and head and neck tumor. The aim of this study is to analyze the risks of microvascular surgery and whether or not happening of more complication in elderly patients who are older than 60 years old and to suggest the solution of the complication. The retrospective study included 41 elderly patients who underwent treatment of 44 microsurgical reconstructions among total 271 cases of microsurgical reconstruction from July, 1988 to December, 1998. Their ages ranged from 61 years to 79 years. There were 26 males and 15 females. The involved sites were 23 head and necks, 13 upper gastrointestinal tracts, 3 lower extremities, 1 chest and 1 sacral region. The causes of microsurgical reconstruction were 36 head and neck tumors, 2 radionecrosis, 2 traumas and 1 melanoma in lower limb. The used flaps were 14 radial forearm flaps, 13 jejunal flaps, 10 latissimus dorsi muscle flaps, 3 rectus abdominis muscle flaps, 2 lateral arm flaps, 1 scapular flap, and 1 iliac osteocutaneous flap. They had medical problems which were 29 tobacco abuse, 14 hypertensions, 13 alcohol abuse, 10 chronic obstructive pulmonary diseases, 7 diabetes mellituses, 3 ischemic heart diseases. All patients have had successful results without specific complications except 3 cases of free flap failure and 3 perioperative death. The causes of 3 flap failures were 2 flap necrosis due to arterial insufficiency and 1 flap loss due to secondary infection. All of these cases were treated with secondary free flap surgery. However 3 patients died perioperatively due to 2 respiratory arrests and 1 sepsis. It was not related to operate microsurgical reconstruction itself, but was correlated with the complication of postoperative care after head and neck surgery. We conclude that plastic surgeons consider the importance of prevention of expected complication as thorough analysis of operative risk factor and appropriate treatment. We had to select the donor and recipient vessel appropriately to perform successful microsurgery in elderly patients and consider vein graft and end-to-side anastomosis to reduce complication if necessary. In addition, we emphasize the importance of pre, peri and postoperative care in head and neck cancer patients to reduce postoperative complication and morbidity.

• Clinics in Shoulder and Elbow
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• v.17 no.2
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• pp.68-76
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• 2014

Background: Recently, reverse total shoulder arthroplasty (RTSA) has been accepted as a main treatment option in irreparable massive rotator cuff tear with cuff arthropathy. The purpose of this study was to evaluate the early complication incidence and the preliminary clinical results of RTSAs performed in single institute. Methods: Fifty-seven RTSAs (56 patients) were performed between April 2011 and March 2013. The indications for RTSA were cuff tear arthropathy and irreparable massive rotator cuff tear with or without pseudoparalysis. Exclusion criteria were revision, preoperative infections and fractures. At final follow-up, 45 shoulders were enrolled. Mean follow-up duration was 12.5 months (range, 6-27 months). The mean age at the time of surgery was 73.6 years (range, 58-87 years). All the patients were functionally accessed via Constant score, American Shoulder and Elbow Surgeons (ASES) score, pain and functional visual analogue scale (VAS) scores and active range of motion. Complications were documented as major and minor. Major complications include fractures, infections, dislocations, nerve palsies, aseptic loosening of humeral or glenoid components, or glenoid screw problems. Minor complications include radiographic scapular notching, hematomas, heterotopic ossification, algodystrophy, intraoperative dislocations, intraoperative cement extravasation, or radiographic lucent lines of the glenoid. Results: The mean Constant score increased from 31.4 to 53.8 (p < 0.001). The pain and functional VAS scores improved (5.2 to 2.7, p < 0.001, 4.0 to 6.7, p < 0.001) and active forward flexion improved from $96.9^{\circ}$ to $125.6^{\circ}$ (p = 0.011). One or more complications occurred in 16 (35.6%) of 45 shoulders, with one failure (2.2%) resulting in the removal of implants by late infection. The single most common complication was scapular notching (9 [20%]). There were 4 (8.9%) axillary nerve palsies postoperatively (n=3: transient n. palsy, n=1: Symptom existed at 11 months postoperatively but improving). Conclusions: In a sort term follow-up, RTSA provided substantial gain in overall function. Most common early complications were scapular notching and postoperative neuropathy. Although overall early complication rate was as high as reported by several authors, most of the complications can be observable without compromise to patients' clinical outcome. Long term follow-up is required to clarify the clinical result and overall complication rate.

• 대한방사선치료학회:학술대회논문집
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• 2005.06a
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• pp.23-26
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• 2005

Introduction: To evaluate whether modified MUPIT applicator can effectively eradicate recurrent tumor in uterine cervix cancer and reduce rectal complication after complete radiation treatment. Methods and Materials: Modified MUPIT applicator basically consists of an acrylic cylinder with flexible brain applicator , an acrylic template with a predrilled array of holes that serve as guides for interstitial needles and interstitial needles. CT scan was performed to determine tumor volume and the position of interstitial needles. Modified MUPIT applicator was applied to patient in operation room and the accuracy for position of interstitial needles in tumor volume was confirmed by CTscan. Brachytherapy was delivered using modified MUPIT applicator and RALS (192-Ir HDR) after calculated computer planning by orthogonal film. The daily dose was 600cGy and the total dose was delivered 3000cGy in tumor volume by BID. Rectal dose was measured by TLD at 5 points so that evaluated the risk of rectal complication. Result: The application of modified MUPIT applicator improved dramatically dose distributions in tumor volume and follow-up of 3 month for this patient was clinically partial response without normal tissue complication, Rectal dose was measured 34.1cGy, 57.1cGy, 103.8cGy, 162.7cGy, 165.7cGy at each points, especially the rectal dose including previous EBRT and ICR was 34.1cGy, 57.1cGy Conclusion: Patients with locally recurrent tumor in uterine cervix cancer treated with modified MIUPIT applicator can expect reasonable rates of local control. The advantages of the system are the fixed geometry Provided by the template and cylinders, and improved dose distributions in irregular tumor volume without rectal complication

• Journal of Chest Surgery
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• v.6 no.2
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• pp.219-224
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• 1973

82 cases of esophageal stenosis due to lye solution in our hospital, which is surgicallly treated with retrosternal esophagoplasty were reported. female was 2 times more then male and average age is 30 years old. Dyphagia and precordial pain were chief complaint. In this technique, jejunum, right and left colon were substituted for constricted esophagus. Postoperative complication rate 14.6%, mortality rate due to other complication were 21.9% but had not seen in this operative technique.

• Journal of Chest Surgery
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• v.23 no.2
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• pp.386-389
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• 1990

Spontaneous Pneumothorax as a complication of lung cancer is rare, as seen from the literature, comprising only 1.13 per cent of all pneumothoraces. All histologic types of lung cancer have been reported principally squamous cell carcinoma probably because of its relatively higher incidence. Beside the fact that it occurs in the same high risk population [Smokers, chronic bronchitis and those with emphysema], pneumothorax may reveal a cancer. Recently, we observed three cases of lung cancer with spontaneous pneumothorax, the one was squamous cell carcinoma and the others were adenocarcinoma. Three cases of spontaneous pneumothoraces occurred as a complication of neoplastic disease.

• Journal of Chest Surgery
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• v.28 no.5
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• pp.510-512
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• 1995

Reexpansion pulmonary edema following treatment of pneumothorax and pleural effusion is a rare complication. However, because of possibility of its fatal outcome, physicians must be aware of this complication and every effort must be made to prevent its occurrence. We experienced 5 cases of reexpansion of pulmonary edema. One was complete tension pneumothorax and became death despite of intensive management. Remained four were 3 pneumothoraces and 1 pleural effusion and discharged without event, fortunately.

• Journal of Chest Surgery
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• v.28 no.5
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• pp.504-506
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• 1995

Postpneumonectomy empyema is an infrequent but dreaded complication. The seriousness of this complication is impossible to eliminate the space containing the infection, and consequently, it is difficult to sterilize the space. The time from pneumonectomy to the development of an empyema ranges from several days to several years, with most evident with 4 weeks. We experienced a case of postpneumonectomy empyema that occurred 27 1/2 years after initial pneumonectomy. She was treated with intrapleural antiseptic irrigation and open-tube drainage following partial decortication. The patient had an uneventful recovery and was discharged from hospital with improved condition.

• Journal of Chest Surgery
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• v.27 no.12
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• pp.1047-1051
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• 1994

Airway obstruction may be caused by extreme mediastinal shift and rotation after right pneumonecotmy or after left pneumonecotomy in the presence of right aortic arch.We experienced such a complication after right pneumonectomy, so called right postpneumonectomy syndrome. The patient was 28 years old female, and 4 month ago she had undergone right pneumonecotomy via video assisted thoracoscopic surgery[VATS] for endobronchial tuberculus dissemination and secondary pulmonary infection. She was treated by mediastinal repositioning which were composed of substernal fixation of pericardium and insertion of expandable prosthesis of 1000 cc capacity. She had good postoperative course and now she feels no obstructive symptoms.

• Journal of Chest Surgery
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• v.26 no.7
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• pp.552-556
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• 1993

Infection after reconstructive surgery is one of the most catastrophic postoperative complication in vascular surgery. Mortality rates reported from a world-wide experience range between 25 and 88 percent. The surgeon faced with such a complication must choose among many diagnostic and management options to maximize limb salvage and survival based on the presentation and site of the infectiota the degree of ischemia of the lower extremities, and the overall medical condition of the patient. We successfully managed with descending thoracic aorta-to-bifemoral arteries bypass after the entire removal of the infected axillo-bifemoral graft because of bypass graft infection.

• Journal of Chest Surgery
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• v.15 no.4
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• pp.428-431
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• 1982

A vascular complication caused by lumbar disc surgery is not infrequent till recently after the first report by Linton & White in 1945. In October 1980, we experienced one case of arteriovenous fistula following lumbar disc surgery in the department of thoracic surgery, CAFGH. The A-V fistula was situated between left common iliac artery and vein, which was confirmed by angiography easily. The A-V fistula was corrected surgically by Taylor`s method successfully without complication.